Cigarette and alternative tobacco product use among adult cancer survivors enrolled in 9 ECOG-ACRIN clinical trials.

BACKGROUND: While cigarette smoking has declined among the US general population, sale and use of non-cigarette alternative tobacco products (ATPs; e.g., e-cigarettes, cigars) and dual use of cigarettes/ATPs are rising. Little is known about ATP use patterns in cancer survivors enrolled in clinical trials. We investigated prevalence of tobacco product use, and factors associated with past 30-day use, among cancer patients in national trials.

METHODS: Cancer survivors (N=756) enrolled in 9 ECOG-ACRIN clinical trials (2017-2021) completed a modified Cancer Patient Tobacco Use Questionnaire (C-TUQ) which assessed baseline cigarette and ATP use since cancer diagnosis and in the past 30-days (30d).

RESULTS: Patients were on average 59 years old, 70% male, and the mean time since cancer diagnosis was 26 months. Since diagnosis, cigarettes (21%) were the most common tobacco product used, followed by smokeless tobacco use (5%), cigars (4%), and e-cigarettes (2%). In the past 30d, 12% of patients reported smoking cigarettes, 4% cigars, 4% using smokeless tobacco, and 2% e-cigarettes. Since cancer diagnosis, 5.5% of the sample reported multiple tobacco product use, and 3.0% reported multiple product use in the past 30d. Males (vs. females) (OR 4.33; p=0<.01) and individuals not living with another person who smokes (vs. living with) (OR 8.07; p=0<.01) were more likely to use ATPs only vs. cigarettes only in the past 30d.

CONCLUSIONS: Among cancer patients, cigarettes were the most prevalent tobacco product reported.

IMPACT: Regardless, ATPs and multiple tobacco product use should be routinely assessed in cancer care settings.